TAKING NOTICE OF THE DEATH SPIRAL:

Columnist Nat Hentoff, Washington Times expose dangerous

provision in Baucus health care bill

WASHINGTON – Two pieces this week exposed the "death spiral" provision in the health care bill offered by Senate Finance Committee Chairman Max Baucus (D-Mt.), penalizing Medicare doctors who provide higher levels of medical treatment to seniors.  As noted in NRLC's September 23 release, Senator Jon Kyl (R-Az.) is offering an amendment in the Senate Finance Committee to strike the provision.

The provision, on pages 80-81 of the Chairman's Mark, establishes that for at least five years, Medicare physicians who authorize treatments for their patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year [see note at end].

Formerly of the Village Voice, nationally renowned columnist Nat Hentoff observed in his syndicated column earlier this week:

...Medicare doctors will not be the only losers. As the doctors struggle to keep abreast of the continually falling limit of the money they can authorize for their contingent of patients, consider what those patients will lose in the quality of their treatment.

In an editorial citing both Hentoff and National Right to Life, the Washington Times declared that the "Baucus bill pressures doctors to stop treatments" and concluded that the unamended bill would encourage doctors to "prescribe cheaper care…to avoid the penalties."

In exposing the "offending provision," the Times accurately concluded:

Forget results. This provision makes no account for the results of care, its quality or even its efficiency. It just says that if a doctor authorizes expensive care, no matter how successfully, the government will punish him by scrimping on what already is a low reimbursement rate for treating Medicare patients. The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. And because no doctor will know who falls in the top 10 percent until year's end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties.

As National Right to Life Executive Director David N. O'Steen, Ph.D. has previously noted: "This provision creates a cruel death spiral. By financially penalizing Medicare providers, the Baucus bill sets up the cruelest and most effective way to ensure that doctors are forced to ration care for their senior citizen patients.  Instead of bureaucrats directly specifying the treatment denials that will mean death and poorer health care for older people, it compels individual doctors to do the dirty work."

Mr. Hentoff's column is available here: http://www.wnd.com/index.php?fa=PAGE.view&pageId=110710

The entire Washington Times editorial can be viewed here: http://www.washingtontimes.com/news/2009/sep/25/death-panels-by-proxy/

More information on the death spiral provision is available from National Right to Life's Powell Center for Medical Ethics at: http://powellcenterformedicalethics.blogspot.com

Note:

1. On pages 80-81 of the 8.16.2009 Chairman's Mark, in the "Expansion of Physician Feedback Program" in Title III, Subtitle A, Part I; specifically, at the top of page 81: "Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician's resource use is at or above the 90th percentile of national utilization. After five years, the Secretary would have the authority to convert the 90th percentile threshold for payment reductions to a standard measure of utilization, such as deviations from the national mean."

The Congressional Budget Office (CBO) rates this as taking $1 billion from Medicare payments over a period of 6 years. See CBO 9/16/09 letter to Chairman Baucus, Table, page 3 of 7. 

The National Right to Life Committee, the nation's largest pro-life group is a federation of affiliates in all 50 states and 3,000 local chapters nationwide.  National Right to Life works through legislation and education to protect those threatened by abortion, infanticide, euthanasia and assisted suicide.